MALASSEZIA 363 



gonadal function, one Avould not expect an increase of baldness in women 

 following the adoption of bobbed hair, while if long hair prevents infection, 

 one would expect an increase. 



When developmental processes in the fetus are at their height, the seba- 

 ceous glands are very active, producing a desquamating layer of fatty cells, 

 the vernix caseosa. A few days after birth the vernix caseosa is shed, and the 

 superficial laj^er begins to keratinize gradually. Here the Malassezia attacks 

 the scalp and the pilosebaceous glands about the face, giving rise to the condi- 

 tion known as miliary sebaceous acne. More rarely it attacks the sebaceous 

 glands of the front or the back of the chest, giving rise to grouped comedones. 

 After the child is three years old, there is little chance of further infection 

 until puberty, as the functions of these glands and of the gonads are in abey- 

 ance. At puberty, both glands again become active, the sebaceous glands, 

 often predisposed to the infection by Malassezia, giving rise to pityriasis and 

 acne. The complexion is muddy, the skin is coarse, greasy and thickened, the 

 mouths of the sebaceous glands are large and those about the nose blacked by 

 comedones. This condition (keratosis) may persist throughout the period of 

 sexual activity, but it usually disappears in early adult life (about 25). 

 Women are not prone to pityriasis but, in those suffering from acnes, there is 

 often a relationship with the menstrual cycle and gonadal activity. In men, 

 at the height of their sexual activity (between 30 and 40 years old), baldness 

 appears on the scalp, and the infection extends to other portions of the body. 

 Later in life we find sebaceous cysts and still later seborrheic warts. Sabou- 

 raud has attempted to correlate baldness with excessive activity shortly after 

 puberty but the difficulty of measuring this activity and of securing reliable 

 data is so great that his results are inconclusive. 



Customs and habits often play a large part in the spread of the disease. 

 Customs which tend to keep the skin very oily and in low humidity seem to 

 favor its spread, such as anointing the scalp with oil, infrequent bathing, etc. 

 The wearing of hats, often decried, seems to be unimportant ; for example, the 

 bareheaded, short-haired, middle class Bengali is very apt to be bald while 

 the Pathan, with long hair, covered with a hard kulor and surrounded by a 

 turban is practically free from baldness. Excessive amounts of carbohydrates 

 and fats or of alcohol tend to increase the greasiness of the skin and pre- 

 dispose to infection as do warm, dry atmospheres. 



In infancy, the lesions commence on the scalp as a greasy heaping up of 

 scales, which are often colored dark from accumulated dirt. Thence the in- 

 fection spreads to the face, typically over the flush area of the cheeks. Mild 

 lesions consist of slightly desquamating areas with erythema. In severe cases 

 there is usually secondary infection by streptococci. The lesions of the head 

 and face frequently become infected by a secondary impetigo and the disease 

 spreads rapidly over the scalp, face, behind the ears, neck, and even on the 

 body. In some children the fungus may involve the forehead, producing tiny 

 vesicles caused by blocking the sebaceous glands of this region. It may also 



